title: Does the revised International Federation of Gynecology and Obstetrics staging system for endometrial cancer lead to increased discrimination in patient outcomes?
abstract: BACKGROUND
  Recent changes were made to the International Federation of Gynecology and Obstetrics (FIGO) staging system for endometrial cancer. The objective of this study was to compare survival outcomes for patients who were staged according to the 1988 FIGO staging system versus the 2009 FIGO staging system.
  
  
  METHODS
  Data were obtained from the Surveillance, Epidemiology, and End Results Program for the years 1998 to 2006. Patients who had a diagnosis of adenocarcinoma of the uterus with complete staging information were included. Patients were staged according to the 1988 and 2009 FIGO staging systems, and Kaplan-Meier estimates were derived for cause-specific survival (CSS). Univariate and multivariate analyses using Cox proportional hazards models were used to identify the factors associated with survival.
  
  
  RESULTS
  In total, 47,284 patients were included. The median follow-up was 37 months. The 5-year CSS rates for patients who had 2009 FIGO stage IA and IB disease were 96.6% and 89.9%, respectively (P < .0001). After accounting for age, grade, and race, this survival difference remained significant (hazard ratio [HR], 1.97; 95% confidence interval [CI], 1.74-2.24; P < .0001). Patients who had 1988 FIGO stage IIA disease had a 5-year CSS rate similar to that of patients who had 1988 FIGO stage IC disease (88.6% vs 89.9%, respectively; P = .09). Patients who had positive pelvic washings had a 5-year CSS rate similar to that of patients who had stage IIIA disease according to the 2009 FIGO system (74.2% vs 72.1%, respectively; P = .37). The 5-year CSS rate for patients who had stage IIIC1 disease was significantly improved compared with that for patients who had stage IIIC2 disease (68.2% vs 57.3%, respectively; P < .0001). In the multivariate model, the survival difference remained (HR, 1.49; 95% CI, 1.26-1.76; P < .0001).
  
  
  CONCLUSIONS
  The 2009 staging system for endometrial cancer produced better discrimination in CSS outcomes compared with the 1988 system.
authors.affiliation: Department of Radiation Oncology, University of Utah Huntsman Cancer Hospital, Salt Lake City, Utah 84112, USA.
authors.forename: Ellen W
authors.initials: EW
authors.lastname: Cooke
authors.forename: Lisa
authors.initials: L
authors.lastname: Pappas
authors.forename: David K
authors.initials: DK
authors.lastname: Gaffney
mesh_terms: D016889:Endometrial Neoplasms / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D018426:SEER Program; D015996:Survival Rate; D016896:Treatment Outcome